Day 43 - Staying on top of it all

Daniel is off to the tub room this morning and walked again there with a round of applause from all the unit staff as he passed the group doing morning rounds. One of his first nurses, J., who's been away on vacation is working with Dan today. She happens to live about a block from our home which is neato. She had not seen Daniel since his first week here and was amazed with his progress. Hearing this report gives us perspective and pride in Daniel's healing ability. We sometimes lose our own sense of progress when we're here everyday for ten hours or more. Still though, we see his progress and are starting to hear how we will soon he off the Burn ICU - well at least the extreme ICU status that he's been in since arriving. His next move might be down the hall

Fun fact: Sweat glands Not sure if I mentioned this before, but the parts of Daniel that were burned and had grafts will no longer sweat. A burn as deep as his burns where all the skin is removed means the sweat glands are gone too. They never grow back. His donor sites will still sweat - so his legs will perspire, but not his chest, back and arms. This may mean taking extra precaution with heat exposure during the summer, but we don't know much more about this aspect of his recovery yet.

Other anatomical changes with full thickness burns like Daniel's are likely to include:

• Time to heal - Scar tissue takes longer to heal if an abrasion occurs later on
• Need for skin lotion - skin needs to stay moist
• Color changes - Melanocytes in skin contain the pigment. Donor skin may not match 
• Changes in sensation - skin may itch (if dry), temperature sensation may be out of whack, numbness
• Changes in strength of skin - burned skin scars over once healed and is 20% weaker than normal, ill-fitting clothing may damage skin
• Pain (still) - grafted skin is tight and takes more than a year to "learn" to stretch into its new location

Skin Tissue

Today for breakfast the kitchen sent the "chef's preference" to Daniel's room and it included a bunch of items he can't eat like dairy and wheat. Luckily his nurse was aware that he had some food limitations. We discussed this mistake with his nutritionist during rounds. She will help the kitchen figure out what he can and can't have even if someone asks for a generic dish like "blue plate special" or whatever.

Daniel's next and final (we hope) surgery may be next Tuesday. His donor sites are about ready. They will be able to use skin on his back that didn't burn or has healed along with skin from his legs if needed. That should give you an idea of how nicely parts of his back have healed. If this final graft goes well then we can begin to focus on recovery. His body will shift gears too and his healing will begin to speed along.

His arms are looking really nice now. Those were the first to heal and the skin is looking great. His joints are really stiff and there's got to be huge pain from the way he reacts to moving them, but the skin itself looks amazing.
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Dan is back from wound care. He will rest and recover from the hard working-over he gets during care. Once he's recuperated some we will move him to a chair to eat some lunch and then we'll finish with a walk around and back to his bed to relax into the evening.
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Daniel's OT came in and stretched his arms and joints (since they were unable to stretch him in wound care today). He seemed to show pretty good tolerance to the pain of stretching and then the plan was to get him in a chair for awhile, then have his PTs walk him around the floor for a bit then straight to bed to rest.

We got Daniel up and into a chair around 1pm, but today he was just not comfortable. His nurse J. pushed some pain meds, but it didn't seem to help him relax. His heart rate stayed up in the 150s and didn't seem to settle down to his resting rate of 120-135s. (Yes, when you're healing from burns your heart rate runs high all the time). Even with the pain meds on board Daniel continued to look uneasy and moaned a little letting us know he would be perfectly happy to get back in bed if that were possible. We tried to give him some food, but he wanted none of that. We kept him sitting for 35 minutes watching a video, then helped him back into bed. A puzzle seemed like too much to ask of him at this time.

Once he was settled in and rested for awhile I sat him up in bed and gave him some food for a late lunch. His heart rate returned to the 135 range, but he still seemed a bit "off" in mood and the general look on his face said to me he didn't feel great or was in some pain/uncomfortable. We managed to get all of his tuna salad, peaches, AJ and about 1/2 of a little Pepsi down so that was good. His mood still seemed off, but I really wanted to have him eat everything - which he did! Then we eased him back and let him relax.

His nurse was concerned with his ECG readings. He's shown some numbers that might indicate that his heart was doing weird things, but we've seen this before since he's been in the ICU and so it seemed like an over precaution, but still just the same it was good that his nurse is watching him closely. The ECG on his regular monitor can sometimes emit weird readings; also it's difficult to get good leads on him since his chest is scarred and covered in dressings. They tried to get all the leads on him using a special ECG monitor, but they were only able to get similar readings with an incomplete set of leads connected so I'd say what they were looking for was still inconclusive.

Daniel continues to rest, I've turned down the lights and we're watching Frozen. He's awake and seems fine. It may just be that the wound care was harder on him and he just wasn't up for doing a whole lot of extra activities today. Everybody has an off day - maybe this was his, so it seemed prudent to take things easier today.

Tonight we'll give Daniel another opportunity to eat some food, but right now he's napping. The nutritionist has ordered a change so that he will be tube fed at night between 4pm and 6am, then during the day we will help to get food in him and hopefully stimulate his interest in food during the waking hours.